MoD 12 Neoplasia 4

Question 1

What are the the top 4 types of cancer and what proportion of cancer incidence do they represent?

Answer 1

Breast (15%)
Lung (13%)
Prostate (13%)
Bowel (13%)
approx 50%

Question 2

What type of cancer is the leading cause of cancer deaths?

Answer 2

lung

Question 3

What factors need to be taken account for when predicting outcome?

Answer 3

Age
General Health
Tumour site
Tumour type
Grade
Tumour stage
availability of effective treatments

Question 4

What is tumour stage?

Answer 4

Measure of tumour burden?

Question 5

What system is used to determine tumour stage?

Answer 5

TNM (tumour node metastasis)

Tumour given value I-IV

Question 6

What system is used to stage lymphoma?

Answer 6

Ann Arbor
I- no metastases
II- Metastases at surrounding lymph nodes
III- Metastases on opposite side of diaphragm to primary
IV- Metastases in an extra-lymphatic organ e.g bone marrow, lungs

Question 7

What is Duke’s staging used for and what are the stages?

Answer 7

Colorectal carcinoma
A- invasion contained within bowel wall (muscularis mucosa)
B-Invasion through bowel wall (outside muscularis mucosa)
C-invasion of lymph nodes
D- Distant metastases in other organs most commonly liver (rarely not)

Question 8

What does grading of tumours measure?

Answer 8

How well differentiated the cells are

Question 9

Typically what do the different grades mean?

Answer 9

G1- well differentiated
G2- moderately differentiated
G3-poorly differentiated
G4- undifferentiated/anaplastic

Question 10

Whhat problem can the general tumour grading system have?

Answer 10

Inter-observer variability

Question 11

What grading system is used for Breast carcinoma?

Answer 11

Bloom-richardson

Assesses tubule formation, nuclear variation and number of mitoses

Question 12

What are the 4 main types of cancer treatment?

Answer 12

Surgery
Radiotherapy
Chemotherapy
(Hormone therapy)
Targeted therapy- drug targets specific receptor or gene

Question 13

What is adjuvant treatment?

Answer 13

Treatment given after surgical removal of tumour to eliminate subclinical disease

Question 14

What is Neoadjuvant treatment?

Answer 14

Treatment given to reduce primary tumour size prior to surgical excision

Question 15

How does radiotherapy kill proliferating cells?

Answer 15

Triggers apoptosis- by causing direct or free radical DNA damage which is recognised at checkpoints
Interfering with mitosis- Double stranded DNA breaks cause damaged chromosomes that prevent mitosis completing correctly

Question 16

What precaution is taken in radiotherapy?

Answer 16

Shielding of surrounding healthy tissue

Question 17

Why is radiotherapy given in multiple small doeses as opposed to one large dose?

Answer 17

This reduces the amount of normal cells lost as they have time to recover the population a bit

Question 18

What do antimetabolites do? Give an example

Answer 18

Mimic normal substances involved in DNA replication, inhibiting them from partaking in DNA replication
Fluorouracil

Question 19

What do alkylating and platinum-based drugs do? Give an example

Answer 19

Cross link DNA interfering with replication

e.g cyclophosphamide and cisplatin

Question 20

Give an example of a plant derived drug and what it does

Answer 20

Vincristine. Blocks microtublulr assembly so interfering with spindle formation

Question 21

Is chemotherapy specific to cancer cells?

Answer 21

no

Question 22

What do SERMs do?

Answer 22

Selective oestrogen receptor modulators (SERMs), such as tamoxifen bind to oestrogen receptors preventing oestrogen from binding. They are used to treat hormone receptor positive breast cancer

Question 23

What hormones are blocked in prostate cancer hormone therapy?

Answer 23

androgens

Question 24

What are tumpur markers useful for?

Answer 24

Monitoring a tumour after surgery to see if it starts growing again

Question 25

What problems can screening have?

Answer 25

Lead time bias
Length bias
Over diagnosis